The blog prince

Might it be vulgar to enquire as to whether one manages to 'blog' regularly enough? This fascinating term is tossed about with alacrity between web-surfers roaming our burgeoning e-society, and it has nothing to do with the peddling of virtual wares. A blog is a web-log, a new online `view-airing' trend whose budding protuberance is, exactly that. They say that two new blogs are born with every tick-tock of the clock. That's one new blog-per-tick, or 60 each minute.

For those yet to stumble upon this sweeping craze, blogs are DIY opinion columns - a rambling collection of personal views published on the internet, usually on somebody's private pages.

Why? - freedom of expression. Some say that bloggers are an impassioned group of campaigners who believe that the 'real truth', about Machiavellian pharmaceutical companies for example,should be outed - so that people (the general public, patients, doctors and any curious online punter) can know the 'hidden' motivations, 'dangers' and 'evidence that all marketers are liars'.

Others would go further and say that some blogs are nothing less or more than the ill-informed machinations of an egotistical and disenchanted bunch. If that seems strong, a quick internet search will reveal in a split second examples, albeit at the extreme end, of what is now so commonplace on the interweb: 'The awful evil pharmaceutical industry, which is intolerably horrible in general, has resorted to stealing and selling penniless grandmothers in the name of profit...' and so on.

There are also so-called 'news' stories informing us of abhorrent acts committed by unscrupulous business people: 'Top pharma executive found trampling on poor Mr Jones' (89) cabbage patch in the name of achieving cost-efficiencies (adjusted for local exchange rates) to the bottom line... '.

Yes - this one-sided portrayal of the web-log maniac is accurate, but also certainly narrow and unfair. The views of this writer may also be quite apparent, but to deliver only my views in this article is to stoop to the allure of the tilted blog. No, please read on for a balanced and open assessment of this gripping new trend as there are important questions to be answered as to its value:

Should our image-sensitive pharmaceutical industry actively monitor what is being written in blogs to learn what people (even patients) really think of its products and promotional activities?

Is there an opportunity for pharma to start bettering its careworn reputation through a targeted 'log on and listen' programme?

After all, the rise of blogging reflects a democratic society which allows freedom of expression, says the Association of the British Pharmaceutical Industry, so if it's honest feedback you want...

True intellect
Firstly, however, there is the question of which among the internet bloggers are actually worth listening to from the perspective of an innovative pharmaceutical business. The raft of opinions presented online include seemingly well-researched and well-presented arguments from professors, ex-high-ranking pharma execs, and even doctors.

Yet, there are many thousands of pages of subjective waffle out there, much of which is paint-dryingly dull and/or utter dross; so would not a disgruntled patient or other genuine detractor always be better served by speaking directly to their own doctor about their concerns, rather than being spoon fed what appear to be the biased views of the, albeit propagating, minority?

There's also the 'shouty' nature of many blogs, which supports the bold egotistical accusation made in paragraph number three. Do a quick Google on pharmaceutical blog and up comes a diverse selection, the bulk of which feature fairly prominently an out of focus mug shot (probably self-taken carelessly by the author using a digital camera) accompanying the key section - About me.

A journalist wrote the article you're reading now, but aside from the assurance that he wasn't dragged in off the street to bang it out (the publisher guarantees that for you), what else do you want to know? Where he went to school? What his preferred painkiller is? Would this information help you to view this feature with a profound level of respect? Thought not.

There are many nits to pick out of blogging but, unlike Channel Four's Big Brother oddity, the practice is not always indubitably rooted in wild accusations, gleeful lies and pertinent misprints. Also, and sadly in similarity to Big Brother, it doesn't appear to be going away.

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This is a growing trend which we need to accept, prepare for and respond to... being in denial, or hiding and hoping it might go away is not an option, says Pfizer's head of patient relationship marketing, Di Stafford, speaking on blogging though her comments are clearly just as applicable to BB and she didn't deny this fact - even though she wasn't asked.

The content of some of the more respectable pharma blog sites seems to be news-led, or at least focused on the bigger issues to break through into the national papers. It is occasionally a mulch of knee-jerk matter, but it is also true that a selection of bloggers are genuine experts who, be they plagued by a yearning to spout off in the first instance, aim to disrupt the regular thinking pattern grooves by provoking and inciting healthy, intelligent debate in an open forum.

One such blogger is the publisher of an online pharmaceutical newsletter (unrelated to any publications from Pharmaceutical Marketing Ltd), who shall be called Cyril in this article for reasons of competition. Cyril is the editor in chief and publisher of an e-publication on marketing, but also runs his own personal internet blog on the pharma industry, and he's not a shrinking violet in either guise.

I started the blog to express personal opinions on the pharma industry that either were not appropriate for my newsletter, or that I felt needed to `get out there' quicker than a monthly newsletter would allow. Although I write an editorial opinion piece in each newsletter, I often don't have the room to fully explore an issue in the same way.

Yet, surely Cyril could use his power and influence skilfully, as head of a pharma publication, to deliver real and honest thought-provoking editorial to the bespoke readers, rather than rely on the interest of whoever comes across his blog site to find this secondary voice?

It could even be argued that his open blog could undermine the credibility and perceived value of his newsletter. If internet users (not pharma experts, remember) accept his blog, led by the honest and persuasive nature of his views, as the 'previously-hidden' truth, why would they bother reading the proper newsletter, which might by contrast seem unable to deliver the real facts?

Do the rules governing good-practice in publishing mean that Cyril is unable to deliver the salient information through his own marketing publication?

I don't know that I would be surprised to hear you say that, but I would disagree that a blog undermines the credibility of a newsletter - at least in my case. You might say that my blog is more journalistic than my newsletter and perhaps purists would then view my newsletter as not really worth reading. But I find very few purists out there and I really do not want them as readers anyway.

Who, then, does Cyril seek to reach through his blog and what are the issues about which he is able only to gush forth in a rivulet of personal assertion (with photo)?

I both hope and fear that pharma people are reading my blog.

Really? What about the risk that your strong personal opinions may affect your business, or people's perception of you?

I fear that what I say may hurt my business, but I also think that a lot of pharma people agree with what I have to say - it may be what they yearn to say, but cannot. It is very difficult to get these people to engage in a dialogue.

Dangerous liaisons
Blogging has a place in our world then, if only to put ajar the door for a select panel to e-opine through online discourse or to air views on issues that are sometimes buried, sat on or suppressed. Fair enough. So is there an opportunity within the blogosphere for the pharmaceutical industry to get involved and even benefit by contributing to this virtual, connected world - through a corporate blog effort maybe?

Yes, says Cyril. I think pharma firms and their agencies - especially PR agencies - should monitor blogs. In fact, they should go even further and have spokespeople who contribute to blogs, I would welcome that.

Ask www.corporateblogging.info why you should blog, and the answer is provided (online): 'From a business perspective there are several potential reasons. Blogs are no different from channels like video, print, audio, presentations and so on. They all deliver results... [and] the kind you can expect from blogs is mainly about stronger relations with important target groups.'

Phrases like 'stronger relations' and `with important target groups' are music to the ears of people who work to promote. However, there is another side to blogging and it focuses less on the potential positives and more on avoiding the negatives.

Consider this notional scenario: you are a concerned patient taking prescription antidepressants who thinks they understand most of what the doctor has told them, and can remember some of it. One lazy afternoon you go online to find out more about your medicine. Following a search taking 0.4secs, you disregard as probably irrelevant an article entitled Scariest drug side effects.

Search again and, 0.33 seconds later, you start to learn [quoted directly as of 12/08/05]:
'I have just taken myself off Zoloft. I know I should have done this through my doctor, but that's another story. I am experiencing dizziness, chills and I am extremely aggravated most of the time. My question for anyone [out there on the internet] is, has anyone had side effects from withdrawal from this drug?' Scary isn't it?

One site perhaps aims to clarify the potential risks in patients' minds and drive them to take doubts directly to a doctor: `Withdrawal from these drugs [SSRIs] can be terrible with bouts of overwhelming depression, insomnia and/or fatigue and can include life-threatening physical effects, psychosis or violent outbursts.' Yet, will it have the desired effect?

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On the same search page is the personal story of a young man, apparently on Effexor XR, for whom `an internet search for Effexor withdrawal has caused me a great deal of concern. I've found mention of severe problems. It turns out that law firms are considering class action against the manufacturer. What have I got myself into? Should I start decreasing the dosage and stopping now before it's too late?'

He's asking `the internet' for advice, and that may be a perilous move. As the ABPI's Matt Worrall puts it: There's a lot of misleading and incorrect information on the internet. Indeed, anyone can write a reply; someone could tell him to knock the drugs on the head immediately and hire a good lawyer, and who knows where that advice may take him? Certainly not where he should go - straight to see his doctor.

Worrall also says, however, that much of what is on the internet is good quality information, and he's right again. The trick is in making the distinction, but can we expect patients and non-pharma folk to do this properly? To choose between a liberated, thought-provoking blog writer and someone who provides seemingly (to the lay reader) well-founded information, but who aims merely to bleat their derisory opinions about in the open?

Blog on
Liz Shanahan, managing director of healthcare PR firm, SantÈ Communications, believes that blogging should be monitored and even challenged where information is so flawed as to be dangerous and/or damaging.

In our industry, we always say that you shouldn't let an error stay unquestioned, because if you do, ultimately you are inadvertently endorsing it - and it doesn't matter whether it's a newspaper, a blog or something else; if it's out there presenting itself as a legitimate position you have got to address it.

She adds that while it is pretty easy to spot the real crackpots, there are some people who believe themselves to be genuinely well-informed and those are the ones that really worry me - they are often well-intentioned individuals but if you know our industry well and you examine it [the blog] a bit more closely, a lot of what is said is scientifically quite flawed, potentially misleading and ultimately very damaging.

With the explosion of the internet over the years, huge numbers of people in Europe now have access to it at work and at home and, without DTC, a good percentage will surely use it regularly as their first port of call for information on medicines. Yet, how can you cater for this and satiate their curiosity?

At the moment there is vacuum whereby patients want more information about their medicines but the industry is unable to provide it, notes the ABPI's Worrall. People accessing blog pages are well aware that they are looking at the personal views of an individual who may not be well informed. The tragedy is that if you want further data from the company that made your medicine, it's not permitted to give it to you. The law currently ties our hands and it's certainly true that the internet is filling that vacuum.

SantÈ is doing some monitoring work for a couple of clients. I think you have to, says Shanahan. You can't leave someone spouting something on a website that isn't correct or is a blatant misrepresentation of the industry. However, your main issue relates to the ABPI Code of Practice. If you're in the UK, and you respond to something on somebody's private internet pages, it could be construed as an example of direct to consumer activity.

Matt Worrall affirms the position: Under the Code, companies can't promote prescription medicines - but they can promote corporate image. Companies can provide information about themselves and this can address misrepresentations or mis-information on the internet.

He adds a note of warning: It is not always appropriate or required to respond directly to privately-held views. The ABPI Code does cover some aspects of conduct by UK firms abroad - which should be cautious about responding to overseas bloggers, especially
if the content in question is relevant for a global audience.

Could happen
Some are already using the `net (GlaxoSmithKline even runs a corporate blog in France - Le Blog), yet for many others any threat from bloggers remains a distant possibility.

In August, the opinion poll on www.pmlive.com asked: `Should pharma monitor what is said about its products in blogs?' The answers `Definitely' and `No' received 17 per cent of votes each, while some 67 per cent of respondents voted `Not currently'. As only six people actually voted (it's normally well over 100 in a week) pharma blogs are clearly not keeping people up at night. Or at least not yet.

Remember that, in the early days they said mobile phones were just a brash luxury for 1980's cash-splash types - and look now, yuppies everywhere! (odds on including you and I). The blog too could rise up in a similar vein. Stranger things have happened - Michael Fish once assured us that if there is one certainty in this life, it's that there is definitely not a hurricane on the way.

I doubt if pharma would ever use blogs to better its image, Cyril opines, but blogs are all about freedom of speech and there is no freedom of speech for employees. Watch this blog...

The Author
James Leeming is a pharmaceutical journalist and a highly trained technophobe